WebEx Recap
Network Provider Training on
Contract Documents and Other System Changes
October 17, 2013
AGENDA
Introduction
2. New Exhibits and Other Cost Accumulator (OCA)
Crosswalk Overview
1.
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3.
Exhibit H, Funding Detail
Exhibit G, Cost Center Funding by OCA
Budget Flexibility
Invoice
Other Related Issues
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Payer of last resort
Invoice Validation Process
4. Adjournment
1. Introduction
 Reinstatement of Sequestration & GAA Reductions
 All Treatment and Prevention Funding Details will be
revised and sent out to Providers.
 Reporting changes
2. Exhibits & Crosswalk
Overview
OCA Crosswalk:
Review of the “OCA Crosswalk.” The table provides a
description from the old OCAs cross walked to the new
OCAs, the related categories and the cost centers by
program.
http://sfbhn.org/wordpress/wp-content/uploads/2OCA-Cross-Walk-October-2013.pdf
2. Exhibits & Crosswalk
Overview
 Exhibit H, Funding Detail
The revised Exhibit H incorporates the new Other Cost
Accumulators (OCAs) in accordance with the Department of
Children and Families (DCF) Approved Operating Budget
(AOB) for fiscal year 2013-2014
As an easy reference and for historical purposes, a two (2)
year history of changes made to the Funding Detail will be
noted at the bottom of the document.
2. Exhibits & Crosswalk
Overview
 Exhibit G, Cost Center Funding by OCA
The format for the Exhibit G has changed. Funding is now tracked by
OCA and Cost Center.
 The OCA allocations are indicated towards the top of the document
underneath the Program headings.
 Rates are on the left side of the document. Open cost centers will be BOLD
and have a rate.
 Highlighted cost centers indicate a TANF eligible cost center.
 Providers will allocate the funds for each OCA across the open cost centers.
2. Exhibits & Crosswalk
Overview
 Budget Flexibility
 Providers will be granted the flexibility to shift funds up to
$25,000 or thirty (30) percent, whichever is higher, between
Alcohol and Drug Other Cost Accumulators (OCA) and
between Residential and Non-Residential Cost
Centers/OCAs.
 Within each OCA there is unlimited flexibility to realign
funds among cost centers.
 Any shift of funds in excess of the aforementioned amounts
will require a formal contract amendment.
2. Exhibits & Crosswalk
Overview
 Invoice
The format for Exhibit E, Monthly Payment/Advance Request, has
changed.
 Local Match, Medicaid, First, Second, Third and SSI/SSDI units shall be
reported on the worksheet section of the invoice and backed out.
 The invoice submission date has changed from the 10th to the 7th calendar day of
the month beginning with November services.
 The implementation date for the revised invoice begins with the November
invoice (due December 7th)
 The invoice validation will be based on the first data run, therefore it is
advisable to report and correct data errors more frequently.
To obtain a copy of the revised invoice, please visit:
http://sfbhn.org/october-17-2013-network-provider-training-on-revised-contractdocuments-and-other-system-changes/
3. Other Related Issues
 Payer of Last Resort
Excerpt from the Revised Exhibit B, Method of Payment to be amended into all contracts
“Third Party Billing
a. The Department is always the payer of last resort. The ME and the Network Provider specifically agree that the
Department, through the ME, is never a liable third party. The Network Provider shall not bill the ME for services
provided to:
i. Individuals who have third party insurance coverage when the services provided are covered under the insurance plan;
or
ii. Medicaid enrollees or recipients of another publically funded health benefits assistance program, when the services
provided are covered by said program, regardless of limitation.
b. The Network Provider may bill the ME if services are provided to:
i. Individuals who have lost coverage through Medicaid, or any other publically funded health benefits assistance
program coverage for any reason during the period of non-coverage; or
ii. Individuals who have a net family income at or above 150 percent of the Federal Poverty Income Guidelines, subject
to the sliding fee scale requirements in Rule 65E-14.018 F.A.C.
c. In no event shall Medicaid, any health insurance, another publically funded health benefits assistance program, or
the ME be billed for the same service provided to the same individual on the same day.”
3. Other Related Issues
 Invoice Validation Process
 Data submission date remains the same: 4th calendar day of the month
following the month of services
 The invoice validation will be based on the first data run
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The move is toward having “real time data” in order for this to occur providers will need to
submit data more frequently. Suggested frequency is a weekly basis if not more.
Orphan service reports will be provided weekly to providers
 Providers are directed to the “Special Allocation OCAs and Matching Modifiers”
table provided.
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Providers with special allocations are required to utilize the special modifiers
effective November 1, 2013. Failure to properly code the services will affect the provider’s
ability to draw down the funding for the special allocation. Similarly, failure to report the
proper modifier will skew the data for other OCAs.
 The OCA modifier (MODIFIER4) will continue to be populated by the SFBHN
IT team until further notice.
http://sfbhn.org/wordpress/wp-content/uploads/7-Special-Allocation-OCAsand-Matching-Modifiers.pdf
SUMMARY
 Exhibit’s E, G, and H have been revised to align with the AOB and to meet new DCF reporting
requirements
 Providers will receive their revised Funding Detail within a week to start the Amendment process
 Data submission date remains the same: 4th calendar day of the month following the month of
services
 Invoice Due Date Effective Immediately: 7th Calendar day of the month beginning with October
2013 services.
 Utilization of Revised Invoice Template: Beginning with November 2013 services
 Invoice validation will be based off of the fist data run
 Implementation of the new data reporting to include Modifiers: Beginning with November 2013
services
 Providers will need to report and correct data errors weekly
 All of the documents presented at the meeting are posted on the following website:
http://sfbhn.org/october-17-2013-network-provider-training-on-revised-contract-documents-and-othersystem-changes